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Chapter 2: History of Mental Health
History of Mental Health Practice in America Mental Illness in Colonial America * Individuals with mental illness considered "cursed souls" and it was believed that mental illness was God's punishment for evil * mentally ill banished from society in the 17th century and forced to stay at home ** this encouraged daily routines in a familiar environment which was positive ** however, created a barrier separating them from society and discouraged social involvement * In agrarian Colonial America- the mentally ill were cared for by families * In puritanical Colonial America- believed that everyone should work and contribute to society. ** mentally ill were a drain on society because they weren't working Urbanization and the rise and fall of Asylums * Mid 18th century- Urbanization during the industrial revolution gave rise to hospitals * Asylums ** usually built on several acres with walkways and gardening activity areas ** Moral Treatment emphasized-''' mentally ill were removed from home and put into asylums with gardens with the hope to calm/ease their minds ** 'Mental Hygiene movement-' religious quakers felt that humane/moral treatment important for people with mental illness ** 'Psychiatrist Benjamin Rush-' helped change the view of mental illness as being evil to biological/psychological causes. *** balanced environmental and biological needs necessary for diagnosis and treatment of mental illness * Asylums started to fail ** healthcare providers weren't properly trained (lack of licensing laws) ** practices became unethical (electroshock, lobotomies, and insulin shock therapy) ** asylums were becoming overcrowded and were decaying due to lack of federal funding. * 20th century- Due to the Great Depression and two world wars, funding was diverted away from mental health ** 1917- OT became an established profession and emphasized a humanistic approach to medicine and focused on the needs of the mentally ill. * Mental Hygiene Movement * 'Clifford Whittingham Beers-' previously a hospitalized patient, wrote about his experiences in the asylum relating the experience to jail ** early 1900's- founded the National Committee of Mental Hygiene (NCMH) and later renamed The National Mental Health Association (NMHA). ** instrumental in obtaining funding such as the Rockefeller Foundation which: *** promoted mental health research *** sought government funding *** established state societies *** protected public's mental health Mental Health Policy * 1900's- several policies established to protect the rights and improve services for people with mental illness ** '1920-' rehabilitation act- addressed needs of people with disabilities ** '''1943- Barden La Follette Amendment expanded the rehabilitation act to include mental illness *** transitional community workshops, outpatient clinics, and day hospitals established ** 1949- National Institute of Mental Health (NIMH) created- important for research, fellowships, grants, and clinics. ** 1954- 'Community Mental Health Services Act in New York said that any city with >50,000 people could create community mental health board. Promoted early community intervention for mentally ill. ** '''1955-' National Mental Health Act- recognized mental illness, supported research and training of mental healthcare professionals. Encouraged research on psychotropic drugs and therapies. ** '1963-' Community Mental Health Act- unsuccessful deinstitutionalization of mental hospitals with insufficient mental health community resources. Led to increased homelessness for mentally ill. ** '''1990- Americans with Disabilities Act (ADA)- addressed issue of isolation/segregation of people with disabilities and increased support for individuals with disabilities. ** '2007- '''The Mental Health Parity Act- addressed the issue of coverage for mental illness. The Consumer Movement * '''consumer/survivor's movement-' equal rights movement to encourage people not to judge/treat others differently because of mental illness. Push to decrease stigmatization. Occupational Therapy Mental Health History * believed that the roots of OT were mental health and moral treatment Consumers' Perspectives * different accounts of people with mental illness and their experiences with OT ** patient stated she enjoyed OT because she got to sew/knit and this was her occupation. However, the OT told her to leave the door open because she couldn't trust the patient with sharp objects. The patient felt powerless. ** 1970's and 1980's- feminist groups teamed up with consciousness awareness groups- helped discharged mentally ill transition into the community ** 1990's- psychologist spoke at the AOTA conference about his diagnosis of schizophrenia. He believed OTs should encourage clients to participate in meaningful activities while working through their illness. Health Providers' Perspectives * Through the 1950's, psychiatrists and physicians (mainly Adolph Meyer and William Rush Dunton, Jr.) were the biggest advocators for OTs in the mental health arena. * 1930's- curative workshops (treatment process meant for people suffering with mental illness became prevalent. ** Activities included arts and crafts, printing and book binding, brick building, and physical activities. However, there were low participation rates and reasons are unclear. ** In prisons, OTs encouraged prisoners to make shoes, kitchen utensils, do metal work, and road work. *** some of these eliminated because people felt that prisoners were being exploited to perform free labor for the prison. * 1940's- World War II veterans returned with mental illness- helped veterans transition into the community by working on ADL's. * 1950's- Community Programs for mentally ill continued- important for social reintegration, guidance, and habilitation. ** mentally ill learned how to "do" skills and participated in activities/crafts that boosted self-esteem. * 1950's-1970's- theories in practice and research emphasized to better serve clients. ** influential OTs- Fidler, King, Llorens, Mosey, and Reilly contributed to psychoanalytic, developmental, behavioral, and sensory integration theories. ** Wilma L. West, an OT, and Lela A. Llorens, an OT and researcher of child mental health. *** This started the Comprehensive Child Care Project at Mount Zion Hospital- worked with at risk families on housing projects. *** opened a new area for OT- community mental health prevention * 1970- West further developed in-home services and halfway houses. * 1970's and 1980's- Robert K. Bing- started multidisciplinary pilot programs in Texas for at risk youth in public schools. * 1970's to present- Field of OT collaborating with other healthcare disciplines to better community programs for mentally ill. ** currently promoting and advocating for evidence-based practice and including research into practice. Recovery * adoption of recovery oriented principles * OT currently marketing itself as a field that embraces recovery and continuing to better understand effects of OT on recovery process. Challenges include: ** educating OTs about recovery ** promote OT in recovery oriented services and facilities